Published online Apr 26, 2020. doi: 10.12998/wjcc.v8.i8.1547
Peer-review started: January 24, 2020
First decision: February 26, 2020
Revised: April 3, 2020
Accepted: April 8, 2020
Article in press: April 8, 2020
Published online: April 26, 2020
Processing time: 91 Days and 3.8 Hours
Cesarean scar molar pregnancy is extremely rare, but the incidence has been rising due to the continuous increase in the rate of cesarean section. The presence of a hydatidiform mole in the scar left on the uterus by the procedure may lead to severe complications. We performed a literature review and found only seven reported cases of cesarean scar molar pregnancy. Accurate diagnosis and appropriate treatment are extremely important for the patients’ prognosis.
A 35-year-old woman, gravida 4, para 1, complained of vaginal bleeding lasting more than 1 mo and amenorrhea lasting more than 2 mo. The patient’s serum human chorionic gonadotropin was 4287800 IU/L. Ultrasound showed a 11.5 cm × 7.5 cm mass at the anterior lower wall of the uterus. The patient underwent suction evacuation, and partial grape-like tissue mixed with blood clots was removed. Uterine arterial embolization was performed to control intraoperative and postoperative bleeding. Histological examination confirmed the presence of a hydatidiform mole in uterine scar. After surgery, there was still a mass with heterogeneous intensity near the isthmus of the uterus on magnetic resonance imaging. The patient then underwent chemotherapy. During the 6-mo follow-up period, the mass disappeared and the serum human chorionic gonadotropin level gradually decreased to normal level.
We report a case of cesarean scar molar pregnancy successfully cured by comprehensive treatment. We found that cesarean scar molar pregnancy was subject to intraoperative bleeding, and uterine arterial embolization before surgery may be helpful.
Core tip: We here report a case of cesarean scar molar pregnancy cured by comprehensive treatment including suction evacuation, uterine arterial embolization, and chemotherapy. We also performed a literature review and found that most cases of cesarean scar molar pregnancy were associated with intraoperative bleeding. Uterine arterial embolization might help prevent massive bleeding if used before surgery.